Plastic surgeon, Dr. Franckle, performs a large number of breast reconstruction surgeries. There are two general types of breast reconstruction: breast reconstruction with your own tissues, such as DIEP Flap/Free Flap Breast Reconstruction and Latissimus Flap/Pedicle Flap Breast Reconstruction, or breast reconstruction with tissue expanders and implants. The most suitable Breast Reconstruction method(s) for your personal situation will be presented to you during your consultation.
Diep Flap/Free Flap Surgery
Plastic surgeon, Dr. Franckle, performs a large number of breast reconstruction surgeries, including breast reconstruction with your own tissues through the method known as DIEP Flap/Free Flap Breast Reconstruction.
DIEP Flap/Free Flap Breast Reconstruction may be needed if you have lost breast tissue and skin following mastectomy—one or both sides—or if you have lost breast tissue only following subcutaneous mastectomy. Uncommonly, the procedure may be helpful if you wish to have larger breasts. The goal of DIEP Flap/Free Flap Breast Reconstruction is the reconstruction of the missing breast(s) or replacement of breast tissue.
A flap of lower abdominal wall fat, muscle, and usually skin, is transferred to the area of missing breast tissue with its own blood supply. In a standard DIEP Flap/Free Flap, the blood supply is within the rectus muscle(s) which is left attached at the lower edge of the rib cage. In a Free TRAM, the blood vessels are reconnected to vessels in the axilla or chest wall. In a Turbocharged TRAM, the muscle is left attached superiorly, but the inferior vessels are connected in the axilla, creating a double-blood supply. The abdominal donor site is closed directly, similar to a Tummy Tuck, leaving a horizontal scar and a scar around the belly button. An attempt is made to create a “normal” breast mound and shape at the first operation, but smaller, subsequent procedures are frequently necessary. Nipple/areolar reconstruction is typically performed at a later date.
A DIEP Flap/Free Flap Breast Reconstruction is a major procedure performed in the hospital and requires at least two to three days of hospitalization. Ambulation will begin the day after surgery and be reasonably comfortable within seven to 10 days. Complete recovery from TRAM Breast Reconstruction usually takes about six weeks. The abdominal donor site causes the most discomfort during healing.
Latissimus Flap/Pedicle Flap
Latissimus Flap/Pedicle Flap Breast Reconstruction may be indicated if you are missing skin and breast tissue following a mastectomy. The goal of Latissimus Flap/Pedicle Flap Breast Reconstruction is the creation of a “breast” that looks essentially normal in clothes and near normal without clothes. In cases where the reconstruction is performed at the same time as a skin-sparing mastectomy, an excellent result with a near-perfect match can be obtained. In cases where larger amounts of skin are lost or in delayed breast reconstruction, the Latissimus flap primarily replaces the skin defect. The scar and shape of the reconstructed breast are both dependent on defect. Generally, the Latissimus Flap/Pedicle Flap Breast Reconstruction requires a breast implant to provide the necessary volume for the final result.
A flap of skin and muscle is elevated from the upper, outer back and rotated to the breast defect. The blood supply is left intact in the armpit (axilla). Usually, but not always, an implant or tissue expander is placed under the flap to provide the correct volume to the reconstructed breast. The back defect is closed directly. Nipple/areolar reconstruction is often performed after healing of the flap to ensure the best possible position.
Latissimus Flap/Pedicle Flap Breast Reconstruction requires one to two days of hospitalization. Discomfort of the back and reconstruction site will be present for several weeks. Full use of the area will require about four weeks of healing. All of the sutures will be removed within a month.
Additional procedures that would enhance the result are enlargement, lifting, or reduction of the opposite breast, and/or nipple (areolar) reconstruction. These procedures are part of the breast reconstruction and usually covered by insurance.
Breast Reconstruction with Implants
There are many different implant options that we can utilize for breast reconstruction. These include silicone and saline implants. The implants are inserted through different incisions that are dependent upon which kind of implant is used. The incisions can be hidden in the crease beneath the breast, around the areola, or under the arm.
As an outpatient procedure, the surgery lasts between one to two hours. The patient will then be fitted with bandages and an elastic bra once all of the incisions have been closed.
It is encouraged that patients rest for up to two weeks after the procedure. Regular activities may be resumed in two to four weeks after surgery, while a full recovery usually takes four to five months.
Other Breast Reconstruction Information
Breast Reconstruction is usually covered by insurance. The specific risks and the suitability of any Breast Reconstruction Procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.